Geriatrics Commons^™

Medication Usage In Independent Living: A Continuing Care Retirement Community Aging In Place Initiative, Aarti Deshpande, Carrie B Rubenstein, Ruth Benfield, Lee Burnside

All Poster Presentations

Purpose: The purpose of the study was to identify medication use concerns in this community.

Background: In this study, Swedish Geriatric Medicine Fellow partnered with this community to identify medication use concerns in this population.

Continuing Care Retirement Communities (CCRCs) are intended to support residents as they age in place. These communities tend to be well resourced but less studied. This survey attempts to identify medication use concerns in this population. Mirabella CCRC has 324 Independent living (IL) residents, 82 of which are couples. The average age is 85 years. The current cost of an IL unit is from $4673- …

Caring For Older Adults In The Hallway Of A Crowded Emergency Department, Rebecca Weeks, Kathy Sawasky, Michael Malone

Journal of Geriatric Emergency Medicine

This paper describes strategies for emergency department providers to address the needs of older adults when facilities are overcrowded and care extends into the hallway.

A Survey Of Delirium Self-Reported Knowledge And Practices Among Emergency Physicians In The United States, Anita N. Chary, Adriane Lesser, Sharon K. Inouye, Christopher R. Carpenter Md, Msc, Amy R. Stuck, Maura Kennedy

Journal of Geriatric Emergency Medicine

Objective: This study aimed to evaluate United States emergency physicians’ self-reported knowledge and practices regarding the detection, prevention, and management of delirium, a common and deadly syndrome that disproportionately affects older emergency department (ED) patients. Knowledge and practices of the broader emergency physician community about these priority topics in geriatric emergency medicine are understudied.

Design: Electronic self-administered online survey

Setting: United States

Participants: One-hundred ninety-seven emergency physicians of the American College of Emergency Physicians Emergency Medicine Practice Research Network

Measures: Descriptive statistics were generated from survey responses.

Results: Of 734 physicians in the research network who were sent the …

It Takes Courage To Pause: Rapid Goals-Of-Care Conversations In The Emergency Department, Anita N. Chary, Aanand D. Naik, Kei Ouchi

Journal of Geriatric Emergency Medicine

n/a

Polypharmacy And High-Risk Medications In Older Veterans Presenting For Emergency Care, Paige Morizio, Vinita Mistry, Ashley Mcknight, Marc Pepin, William Bryan, Ryan Owenby, Laura Previll, Luna Ragsdale

Journal of Geriatric Emergency Medicine

Background: Guidelines suggest screening for polypharmacy and documentation of high-risk medications in the geriatric Emergency Department (ED) setting. The purpose of this quality improvement initiative was to describe high-risk medications and polypharmacy in older Veterans presenting to the ED in order to inform the workflow of a Geriatric ED pharmacist.

Methods: This was a retrospective, quality improvement project that included patients age 65 years or older who presented to the ED between 10/1/2017 and 9/30/2019. The endpoints included the number of patients with at least one high-risk medication and the mean number of medications on the outpatient medication list. The …

Intermediate Care Technicians-A Novel Workforce For Veterans Affairs Geriatric Emergency Departments, Kristina T. Snell, Thomas Edes, Colleen M. Mcquown

Journal of Geriatric Emergency Medicine

No abstract provided.

Geriatric Emergency Medicine Fellowship Journal Club: Frailty, Sarah Keene, Rebecca Fisher, Lauren Cameron-Comasco

Journal of Geriatric Emergency Medicine

No abstract provided.

Ten Clinical Tips In The Assessment Of Genitourinary Emergencies Of An Older Adult, Nicole Soria, Danya Khoujah

Journal of Geriatric Emergency Medicine

Sentinel Paper Review: Exploring Care Transitions From Patient, Caregiver, And Health-Care Provider Perspectives, Kevin T. Fuji, Aaron Malsch, Pamela Martin

Journal of Geriatric Emergency Medicine

No abstract provided.

Can An Emergency Department Adequately Address An Older Adult Who Has Complex Needs?, Rami Tarabay, Adam Perry, Riwa Al Aridi, Michael Malone

Journal of Geriatric Emergency Medicine

Older adults account for a considerable percentage of all emergency departments (ED) patient encounters. Those with very complex needs or multiple co-morbid conditions often have lengthy ED evaluations culminating in admission, many of which are considered potentially avoidable. Provider and process elements can evolve to create efficient and more comprehensive geriatric assessments in ED. This paper describes an older adult with acute on chronic symptoms admitted through the ED to the Acute Care for Elders (ACE) inpatient unit. We illustrate how elements of the ACE model, when applied in the ED, may avoid hospitalization. We review the Domain Management Model …

Caregiver Support In The Emergency Department, Candace Kim, Dawn Butler, Todd C. James

Journal of Geriatric Emergency Medicine

Caregiver support in the emergency department can lead to improved patient care, decreased suffering and lower costs. Identifying caregivers and inviting them onto the healthcare team enhances care. It is useful to document risk factors for caregiver stress and provide resources. The Kingston Caregiver Stress Scale is a tool suitable for assessing needs of caregivers. Multiple health professionals in the emergency department can be utilized to support caregivers.

Unmet Needs And Social Challenges For Older Adults During And After The Covid-19 Pandemic: An Opportunity To Improve Care, Alyssa Elman, Daniel Baek, Elaine Gottesman, Michael E. Stern, Mary R. Mulcare, Amy Shaw, Morgan Pearman, Michelle Sullivan, Sunday Clark, Timothy F. Platts-Mills, Rahul Sharma, Tony Rosen

Journal of Geriatric Emergency Medicine

Many older adults have unmet needs and social challenges that can negatively impact their health and well-being, particularly during and after the COVID pandemic. These include social isolation, inadequate care or assistance with their daily activities, food insecurity, housing insecurity, poverty, and abuse/neglect/exploitation. An ED visit provides a unique and critical opportunity to identify these issues and initiate intervention for these vulnerable older adults. By assessing for unmet needs and social challenges, considering a team-based approach as to how they may be ameliorated, using online tools, and integrating telehealth and EMS, ED providers have the potential to dramatically improve …

Management Of Fall Patients – What Should Be Done For Emergency Department Fall Patients?, Katherine Selman, Christine Binkley, Katherine Davenport, Shan W. Lliu, Maura Kennedy

Journal of Geriatric Emergency Medicine

Falls are the leading cause of injury-related emergency visits in older adults, translating into an estimated 3 million ED visits and 32,000 deaths from fall-related injuries annually in the United States. Falls subsequently result in diminished functional ability and higher risk for future falls and mortality. Despite this, ED clinicians focus primarily on injuries that result from a fall and often defer the modifiable causes of the fall and future fall prevention to outpatient providers. We review two articles that address the feasibility of performing interventions from the ED and the efficacy of a multifactorial fall intervention program.

Using The 4m Model To Screen Geriatric Patients In The Emergency Department, Martinus Megalla, Roopa Avula, Christopher Manners, Portia Chinnery, Lindsey Perrella, Douglas Finefrock

Journal of Geriatric Emergency Medicine

Several models of specialized geriatric care in the Emergency Department (ED) have been developed since the American College of Emergency Physicians (ACEP) began accrediting geriatric EDs in 2018. There is considerable variability in terms of both design and efficacy in regard to screening older patients in the ED and determining proper interventions The John A. Hartford Foundation and Institute for Healthcare Improvement (IHI) have developed the 4M Model for Creating Age-Friendly Health Systems which aims to provide high quality care to older patients by addressing four critical elements: Mentation, Mobility, Medication, What Matters. This article describes a screening tool for …

“I’M Not Staying In The Hospital Tonight”: How Emergency Departments Can Leverage Health And Social Services At Home To Support Care Transitions For Older Patients, Emily Franzosa, Ula Hwang, Maya Genovesi, Orna Intrator, Thomas Edes, Michael Malone

Journal of Geriatric Emergency Medicine

When hospital admission is less than desirable and sending a patient home alone feels unsafe, connecting patients to health and social services at home are a valuable third option for emergency providers. Coordinating home support services from the ED is effective care delivery and aligns with health systems’ goals of decreasing avoidable admissions, and developing capacity to assess and refer patients to home support from the ED is part of good emergency care. Change also doesn’t have to happen overnight. Taking small steps now to improve older patients' transitions to home can help EDs build toward high-quality, patient-centered care for …

Emergency Department - Community Partnership To Coordinate Older Adults Falls Prevention Programs, Suzanne Ryer, Ann Gallo, Adam Perry, Michael Malone

Journal of Geriatric Emergency Medicine

Abstract

Falls and injurious falls are common causes for emergency department visits in older adults. Prior literature describing ED care of older adults has focused on the patients' injuries and their ED care. There is a gap in the literature describing community- based falls prevention strategies and interventions deployed by community organizations, beyond health systems. We identified variation in approaches to older adults among paramedic programs from one community to the next within Milwaukee County, Wisconsin. We also noted no organized falls prevention program spanning all communities, emergency departments and health systems in the county. We describe the implementation of …

Understanding Older Adults Living In Medically Underserved Areas Perspectives Regarding Type 2 Diabetes Care Received, Christopher Rogers

Seton Hall University Dissertations and Theses (ETDs)

Older adults with type 2 diabetes living in medically underserved areas (MUAs) have unique health and social needs that must be taken into consideration when supporting their type 2 diabetes treatment and management care. Effective treatment and management of type 2 diabetes for older adults living in MUAs requires incorporating the preferences, desires, needs, values, and goals of the person at the center of the care into his/her care plan. Shifting care to be conducive to the treatment and management goals and plans co-created with older adults living in MUAs based on their individual physical, psychological, social, and spiritual preferences, …

Addressing Psychosocial Outcomes Of Social Isolation In Older Adults, Megan Friesen, Madeline M. Christensen

Nursing DNP Projects

Purpose and Rationale

The aim of the evidence-based practice (EBP) project is to improve psychological outcomes for socially isolated older adults enrolled in a Homebound Program (HP) through the implementation of an EBP intervention. Social isolation has a multitude of negative consequences, including impacting the psychological health (e.g. depression, loneliness, anxiety) of the older adult population.

Synthesis of Evidence

Meta-analyses, systematic reviews, and randomized controlled trials addressing the clinical problem of social isolation were identified. Through critical appraisal of the evidence, physical activity, psychotherapy, and socialization interventions have shown to decrease depression and loneliness in older adults. There were mixed …

Neither “Post-War” Nor Post-Pregnancy Paranoia: How America’S War On Drugs Continues To Perpetuate Disparate Incarceration Outcomes For Pregnant, Substance-Involved Offenders, Becca S. Zimmerman

Pitzer Senior Theses

This thesis investigates the unique interactions between pregnancy, substance involvement, and race as they relate to the War on Drugs and the hyper-incarceration of women. Using ordinary least square regression analyses and data from the Bureau of Justice Statistics’ 2016 Survey of Prison Inmates, I examine if (and how) pregnancy status, drug use, race, and their interactions influence two length of incarceration outcomes: sentence length and amount of time spent in jail between arrest and imprisonment. The results collectively indicate that pregnancy decreases length of incarceration outcomes for those offenders who are not substance-involved but not evenhandedly -- benefitting white …

The Use Of Life-Like Robotic Animals In The Acute Care Setting To Assist In The Care Of Patients With Dementia, Abby Denby

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The purpose of this pilot project was to describe the effect of life-like robotic animals on the nurses’ ability to provide care, patients’ level of agitation, use of antipsychotic medications, restraint and sitter use for patients with dementia in an acute care setting. Nurses report challenges and feelings of helplessness while caring for patients with dementia. Dementia may cause depression, agitation, aggression (physical or verbal) and a decrease quality of life. Animal Assisted Therapy (ATT) is a growing therapy in many healthcare settings but there is a lack of literature specifically related to the use of AAT in the acute …

Improving Colorectal Cancer Screening And Testing In A Primary Care Clinic, Leslie Michelle Dubois

Doctor of Nursing Practice

Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer-related deaths worldwide (World Health Organization, 2019a). In the United States, CRC was the fourth most common cancer in 2016 (Centers for Disease Control and Prevention, 2019a). The American Cancer Society (2020a) estimated that there will be 147,950 estimated new cases and 53,200 estimated deaths of CRC in the U.S. in 2020. The purpose of the project was to improve CRC screening completion rates and follow up referrals from 27.5% to 35% for adult patients, 50-75 years of age, within a family medicine clinic …

Understanding The Context And Social Processes That Shape Person- And Family-Centered Culture In Long-Term Care: The Pivotal Role Of Personal Support Workers, Ellen Helena Melis

Antioch University Dissertations & Theses

This single, exemplar case study explored the context and social processes that shape person-and family-centered culture in a long-term care (LTC) home, using grounded theory and situational analysis for the data collection and analysis. Findings revealed one core dimension: needing to be heard, valued, and understood, and five key roles: personal support workers (PSWs), executive director (ED), senior leadership, nurse managers, and residents and families, which informed five dimensions, each focused on enhancing care for residents: (a) attending to residents’ daily care needs (PSWs), (b) advocating strategically (ED), (c) translating vision into programs and policies (senior leadership), (d) ensuring quality …

House Calls Are Reaching The Tipping Point — Now We Need The Workforce, Thomas Cornwell

Journal of Patient-Centered Research and Reviews

Home-based primary care (HBPC) improves the lives of high-cost, frail, homebound patients and their caregivers while reducing costs by keeping patients at home and reducing the use of hospitals and nursing homes. Several forces are behind the resurgence of HBPC, including the rapidly aging population, advancements in portable medical technology, evidence showing the value of HBPC, and improved payments for HBPC. There are 2 million to 4 million patients who could benefit from HBPC, but only 12% are receiving it. The number of these patients is expected to double over the next two decades. This requires a larger and better …

Abstracts From The 23rd Annual Health Care Systems Research Network Conference, March 21–23, 2017, San Diego, California

Journal of Patient-Centered Research and Reviews

This proceedings supplement includes selected abstracts presented at the 23rd annual conference of the Health Care Systems Research Network (HCSRN), held March 21–23, 2017, in San Diego, California. Formerly called the HMO Research Network, HCSRN aims to improve individual and population health through research that connects the resources and capabilities of its member health care systems.

Comparing Total Expenditures By Source Of Long-Term Services And Supports., Maresa R. Corder

Electronic Theses and Dissertations

This study compares total expenditures between beneficiaries enrolled in traditional Long-Term Care (LTC) and beneficiaries enrolled in Home and Community Based Services (HCBS) in a Quasi-Experimental Simple Ex Post Facto study utilizing multiple linear regression with inverted propensity score weighting. The results demonstrated, during the two years of the study period, that total expenditures were on average $14,565.03 (with a p-value oflessfor the total two years of the study, for HCBS beneficiaries when compared to their LTC counterparts. There remains today a belief that expenditures of elderly, dual beneficiaries electing to age-in-place for supported self-care expend less than that of …

Dental Care For Older Adults: Regulatory Requirements In Long Term Care Settings, American Dental Association

Action for Dental Health

No abstract provided.

Why Does Oral Health In Long-Term Care Residents Matter? Talking Points For Administrators, American Dental Association

Action for Dental Health

No abstract provided.

Expanding Dental Practices Into Long-Term Care, American Dental Association

Action for Dental Health

No abstract provided.

Patient Satisfaction With The Annual Wellness Visit, Maria Espiridion, Raghavendra Mulinti, Md, Suzanne E. Kemper, Mph, Lynne J. Goebel, Md

Marshall Journal of Medicine

OBJECTIVES - To determine patient satisfaction with the Annual Wellness Visit (AWV)

DESIGN – Survey

SETTING- Charleston Area Medical Center and Marshall Health

PARTICIPANTS – 66 volunteers, average age 74 years

MEASUREMENTS – Patient satisfaction was assessed with a 13 item survey.

RESULTS - Of 1,537 eligible patients, 211 (14%) of these agreed to schedule their AWV. From 66 patients surveyed, 87% of patients said the visit “met expectations,” “would recommend to friends,” and “would do it again.” Only 5 (8%) were disappointed that new problems were not addressed and 2 (3%) were dissatisfied that physical exams and blood …

Implementing A Good Catch Program In Nursing Homes, Leigh Raposo

Muskie School Capstones and Dissertations

Rationale and processes for reporting near misses and evidence-based tools were collected by a literature search, seminal works by Sidney Dekker and James Reason, and websites for the Agency for Healthcare Research and Quality (AHRQ), the Institute for Healthcare Improvement (IHI), and the Centers for Medicare and Medicaid Services (CMS). Tools, information, and strategies found in this research were evaluated for implementation in Maine nursing homes. The tools provide a communication vehicle for nursing home staff to safely report to management near misses, or mistakes that do not harm residents. To emphasize a positive approach, the project replaces the term …